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Garry Rayno's State House Dome: Next up in Concord is deciding Medicaid expansion

By GARRY RAYNOState House Bureau

The biggest issue left unresolved from the 2013 legislative session is whether Medicaid eligibility should be expanded under the Affordable Care Act.

When the House and Senate could not resolve their differences over the issue - the Democratic-controlled House and Gov. Maggie Hassan want to expand the program, the Republican-controlled Senate wants to wait - they did agree to establish a commission to make recommendations by Oct. 15.

Balancing the cost of expansion and the impact of insuring about 48,000 additional state residents is being weighed by the commission.

Members met last week for the third time, hearing from Health and Human Service Department officials. They will meet Tuesday to hear from Insurance Department officials.

Last week, HHS officials presented several options to explore. State Medicaid Director Katie Dunn explained that if the state does nothing to change eligibility, it would save $85 million over the next seven years, mostly from the federal government increasing its share of the Children's Health Insurance Program from 65 to 88 percent.

Officials predict about 4,000 people on Medicaid will move to private health insurance over the period, saving the state $71 million, but more than 3,200 people will join Medicaid because of the individual mandate to have health insurance, costing about $47 million.

A lot of Republicans would like to stop there and not talk about expansion. Democrats, however, say the state would be stupid to turn down about $2.4 billion in federal money over the next seven years.

Currently, about 170,000 state residents are eligible for Medicaid. If the state decides to expand eligibility to 138 percent of the federal poverty level, an estimated 48,000 more people would be eligible.

The federal government will pay 100 percent of the cost of newly eligible Medicaid recipients for three years starting Jan. 1, then gradually reduce its share to 90 percent at the seventh year.

There are options to expanding Medicaid eligibility, including using the state's Health Insurance Premium Payment program, through which Medicaid pays a recipient's private health insurance premium, or using the health insurance exchange and private insurers to provide coverage for those between 100 to 138 percent of poverty.

The private insurer option would require a 1115 waiver from the federal government, but the state lacks a key requirement: that the state offer at least two health care options. The state exchange has only one qualified carrier, Anthem Blue Cross.

Some people believe the three companies the state hired to run the Medicaid managed care system will also jump into the market, but that is far from certain.

The politics of expansion are fairly simple: Republicans don't want the ACA to work so they can use it as an issue for the 2014 elections; Democrats want it to work so they can use it for the 2014 elections.

The commission considering Medicaid expansion comprises five Democrats and four Republicans. Its recommendation will have to go through the Republican-controlled Senate, where the breakdown is 13 Republicans and 11 Democrats.

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MEDICAID PICNIC: One group opposing expansion and anything to do with the ACA, also known as Obamacare, is Americans for Prosperity-New Hampshire.

The group will hold a picnic at noon Thursday on the State House lawn, where subs will be available and participants can listen to speakers talk about the act and its affects on the state.

Organization Director Greg Moore said he wants people to know how the poorly designed and implemented law would affect their lives and health care.

"From cuts in services to higher premiums to doctor shortages to people being dumped from high-quality insurance onto a substandard Medicaid program, Obamacare will impact almost everyone's health care and access to care," Moore said.

Moore will speak at the picnic. Former House Speaker and potential 1st District Congressional candidate William O'Brien may speak, as may state Senate Majority Leader Jeb Bradley, R-Wolfeboro, and Senate commission member Sen. Andy Sanborn, R-Bedford.

Moore said the picnic is also open to ACA supporters, noting that if U.S. Rep. Ann Kuster wants to come speak in favor, she is welcome.

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PUBLIC FORUM: A public forum to help Greater Manchester residents learn about the ACA and its health insurance exchange, Medicaid expansion and other issues will be held in the aldermanic chambers next month.

Democratic Manchester Sen. Lou D'Allesandro said he believes Insurance Commissioner Roger Sevigny and Health and Human Services Commissioner Nicholas Toumpas will be attend to help explain the new health reform law.

The forum is scheduled Aug. 14 at 7 p.m.

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JUDGES IN WAITING: Hassan has some choice appointments to fill: judgeships.

There are 12 full-time vacancies and seven part-time vacancies in the circuit court division, which includes district, family and probate courts.